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I was recently contacted by a family, who suffered the loss of their sweet baby girl in an unlicensed in-home daycare, on January 18, 2013. I am so saddened that though all my efforts these tragedies continue to happen and our lawmakers are still not passing Nathan's Law!

Below is a letter they wrote to their Representative.

To Donna Lichtenegger, District 157:

This letter comes to you in regards to an urgent matter. I feel as though the concerns my family has regarding the death of my daughter, Jane Smith, who on January 18, 2013 was in the care of an unlicensed babysitter, Betty Brown, have been scuttled under the allusion of a no-fault natural death. As one of your constituents, I believe such injustices should with respect, garner attention and interest from you under a commonality of shared beliefs that such actions shall not be tolerated.

The babysitter, Betty Brown (Brown) of Saint Mary, Missouri, was found guilty of watching an excessive number of children (14), of which my wife and I were unaware; at the time my daughter, Jane Smith, was purportedly being watched. To this day, the Perry County Missouri Sheriff’s department and the investigator handling the case, John Doe, have failed to recommend charges in this case. As the parents of this beautiful little girl, we feel it is important to find the truth and educate others as to the potential dangers involved with in-home daycare providers. We are motivated by the inconsistencies of the events that surround her death and the unwillingness of local authorities to investigate without bias. Our daughter was neglected by Brown; left for over 3 hours to fend for herself at the tender age of 7 months old, with 14 other young kids, in proximity to a wood burning stove, and in a inadequately ventilated basement room. According to Brown, Jane was found blue and on her back. During CPR, black material was thrown up by my daughter. This material was never found in her autopsy or toxicology, as the only liquid in her stomach was light colored formula from lunch. After discussing this with several local paramedics not involved in this tragedy; I was told the black liquid was likely blood from her lungs. The Perry County Sheriff’s department, as the originating Law Enforcement agency responding to Brown’s house, is believed to have failed in their duties upon arrival to this situation. The scene (Brown’s Home) was never secured and access restricted to those parties at the scene. Sheriff’s Detective Doe made the presumptive assertion upon his initial contact with us at the hospital, that Jane was a victim of SIDS (Sudden Infant Death Syndrome- a medical diagnosis which should not be presumed at the scene of such an occurrence). It is our belief that Doe and the responding officer failed to properly secure, preserve, maintain and document the scene. In addition, photos were only taken of the area where Brown stated the incident occurred and no clothing evidence from Jane or Marie Johnson (Betty’s first cousin) (first responder whom Jane threw up the unidentified black material on) was ever collected. Jane was noted by paramedics as exhibiting “stiffening” or “rigor” in her extremities upon their initial assessment on scene; this finding lead the ambulance crew to cancel air transportation “AirEvac”, and this information was available to Doe at that time. As Jane very well could have been “gone” long before medical help arrived, the scene should have been treated as a homicide until evidence could prove otherwise; instead the scene was handled as though Brown played no part in Jane’s passing, and her death was naturally occurring. Authorities appear unwilling to hold Brown accountable for such neglectful actions. Neglect or abuse of a child under Missouri Law, statute 568.060 states “(4) the failure to provide, by those responsible for the care, custody, and control of a child under the age of eighteen years, the care reasonable and necessary to maintain the physical and mental health of the child, when such failure presents a substantial probability that death or physical injury or sexual injury would result” and “2. A person commits the offense of abuse or neglect of a child if such person knowingly causes a child who is less than eighteen years of age: (2) To be placed in a situation in which the child may suffer physical or mental injury as the result of abuse or neglect”. Brown made the conscious decision to watch an excessive number of children; to not check on Jane for over 3 hours; and to place her in an environment which lead to her passing. Because Brown knowingly “abandoned” Jane in an environment which could likely result in physical injury or death, it is believed she violated Missouri Statute 568.030, Abandonment of a child in the first degree. Any person, whom violates Missouri Statute 568.045, commits the crime of endangering the welfare of a child in the first by way of knowingly acting in a manner that constructs a considerable hazard to the life, body, or health of a child less than seventeen years old; again perpetrated by Brown in her actions on the day Jane passed. According to Missouri Statute 565.024, involuntary manslaughter in the second degree may be levied when “3. …. he/she acts with criminal negligence to cause the death of any person.”. Watching 14 kids and leaving Jane, a 7 month old infant, in a closed, excessively warm envi-ronment, is negligence. Detective Doe, with his preconceived notion of SIDS, communicating with Brown’s family regarding the details of the ongoing case (believed based on comments made by Brown’s sister), and knowingly failing to collect the appropriate evidence (which could have been used during the autopsy to determine the correct cause of death) was in violation of Missouri Statute 575.020 wherein, Doe conferred biased consideration to any person (Brown’s family) in consideration of that person's concealing of any offense (death from neglect), refraining from initiating or aiding in the prosecution of an offense, or withholding any evidence (clothes from Jane and Marie).

I am writing this letter to plead for help in garnering attention and support for this case with the notion that such attention would allow for a review to be held by third party entities that have no small town affiliations with Perry County Missouri. We believe our daughter, Jane, was in excellent health for her age and there is no reason she should have passed away. We believe the circumstances she was put in by Brown were calculating and indifferent and as such neglectful. Perry County Missouri is a small close knit town, about 30 minutes North of where my family lives. We believe because of the extreme bias present in Perry County, the death of our daughter will not be sought by authorities and the appropriate parties held accountable. We look forward to hearing from you.

Unfortunately, "Nathan's Law" did not pass out of committee this year. We did have a hearing, that I testified at and thought had gone quite well. There was of course, Kerry Messer with Missouri Family Network, who opposed the bill. I am really not sure what to think of him. I don't understand why he doesn't want this bill to pass. I am not trying to regulate grandma, just people who are providing daycare as their business. I want to make sure the kiddos are safe!

Anyway, though the bill didn't pass again this year, I do believe our voices are being heard. Every year we receive more exposure. When I walk the halls of the capital to speak to all the Representatives & Senators, more and more have heard of "Nathan's Law". I know eventually it will pass and have told all of them, I will not stop until it is law.

So, next year, this bill will be filed again. I will continue my fight.

I recently did an interview for KCTV5 in Kansas City, MO. I think the interview went really well and hope it raises awareness and helps get Nathan's Law passed. A few things have happened since I did the interview. I have a sponsor for Nathan's Law. It will again be sponsored by Representative Jill Schupp and she is fighting with major gusto! She is currently looking for Representatives to cosponsor Nathan's Law, so please speak to your representative and ask them to cosponsor this very important bill!

This article/blog entry appeared in the National Policy Blog Promoting Quality Child Care by Grace Reef who is with ChildCare Aware of America (NAACCRA).

Last week, for the fifth year, Rep. Jill Schupp (D-Creve Coeur) in Missouri introduced a bill to save children’s lives. The bill is called “Nathan’s Law,” after a 3-month-old infant in Missouri who died in a child care program.

What’s the issue? Under Missouri law, a child care license is not required until four children are cared for in the home but some children are exempt from the count – the child care provider’s children, grandchildren, nieces and nephews. What this means is that there could be far more than four children in the home without a license.

What’s the big deal? Shelley Blecha, Nathan’s mom, tells a story no parent wants to hear. She received a call from the provider, “come to the day care right away, your baby’s not breathing.” She kept thinking, “please let him be ok, please let him be ok.” But, baby Nathan died.

What happened? A series of problems occurred in the case of the Blecha family:

(1) On the day that Nathan died, the provider was caring for 10 children (with no license).

(2) Baby Nathan was put down for a nap in a portable crib – face down where he asphyxiated against the plastic pad in the bottom of the crib.

Had Nathan been in licensed care, the provider would have been required to put infants to sleep on their back, which studies show reduce the risk of suffocation.

Had the provider been licensed, she might have had some minimum training to look to ensure that the crib sheet fit snugly over the crib pad (to safeguard against suffocation).

(3) On the day that Nathan died, his 3-year-old brother and 8 other young children watched the crisis as paramedics rushed around the scene – the trauma unfolding before the eyes of terrified children.

A 2011 Post-Dispatch investigation found that 41 children, mostly infants, have died in unlicensed care over the last couple of years in Missouri.

A St. Louis today article from last week quotes the Missouri Family Network as saying that families have a right to care for their own children and their relatives in their own way. We agree. But, when a child care provider takes children who are unrelated into her home, the care of that child depends on the child care provider’s ability to care for all children (not just the unrelated ones).

The fact of the matter is that no child is invisible. All children count even if the state looks the other way and doesn’t require some children to be counted. If there were an emergency – maybe a fire that requires evacuation – all children need to be safely evacuated – even the invisible ones. But, how many children, particularly infants and young toddlers, can be cared for safely by one person? How many can be evacuated safely in times of emergency by one adult? How many can be safely supervised to guard against potentially tragic accidents?

Most child care providers love children and they want to care for them, help them grow, and watch them develop. They want children to be safe. They want to provide a nurturing environment. As with all of us, people don’t know what they don’t know. The more children in care, the greater the likelihood that the unthinkable might happen.

What’s the purpose of licensing? For most states, it’s an opportunity for child care providers to learn about the latest in child safety (the “Back to Sleep” campaign recommended by the American Academy of Pediatrics is just one example). It’s an opportunity for some training in CPR and in some states – activities to promote child development. Child care providers often become “like a member of the family.” They want what’s best for children and think of them like their own. But, again, people may mean well, but don’t know what they don’t know.

It’s time for Missouri to put the needs of children first.

How many children can be safely cared for by one provider? (Taking into consideration that emergencies could happen);

Impose stiff fines against illegal providers (those caring for more than the legal limit without a license). The fine has to be high enough to act as a deterrent to risking the life of a child.

The fact that Rep. Schupp’s bill has died four times speaks to the controversy surrounding the issue. It’s time for a national conversation that puts the safety and well-being of children first. This is not about “provider rights.” This is about the rights of children, including infants, to be safe in child care.

Children should not be left to chance. It’s time for Missouri to pass Nathan’s Law. How many children does your state allow to be cared for by one adult before a license is required? Is there an overall cap on the number of children that can be cared for – whether related or not? It’s time to ask. And, it’s time to act. Children’s lives depend on it.

This article was featured in the Post Dispatch on Feb. 1st by Nancy Cambria.

A local lawmaker is again championing a Missouri day care safety bill that has repeatedly failed to gain traction amid opposition by a conservative lobby.

Rep. Jill Schupp, D-Creve Coeur, said this week she will again sponsor Nathan’s Law, a bill that has been proposed annually since 2009. The bill, among other things, takes aim at a licensing exemption allowing Missouri home day care providers to watch more young children without a license than the state limit of four.

“We know that when we put more young kids together under the supervision of one person, we know that tragedies occur. This can head this off before it happens,” Schupp said.

The bill’s proponents argue the exemption has long been a danger to children. A 2011 Post-Dispatch investigation found 41 children, mostly infants, died in unlicensed home day cares from 2007 through 2010, compared with four deaths in both licensed home day cares and licensed centers in the same time period. In many cases, poor supervision involving high numbers of children coupled with unsafe sleeping arrangements for the infants contributed to the accidental deaths.

But detractors such as the Missouri Family Network have said the proposed fix threatens the rights of families to care for their own children and their relatives in their own way, without government intervention. Some worry the bill opens the door to greater intrusions on families who choose to home school or opt out of early childhood programs.

Kerry Messer, president of the Missouri Family Network and a longtime lobbyist, said base philosophies differ on the issue, noting there’s a “legitimate interest on the part of the state to provide adequate protections against bad actors, but then you have the majority of families who have the need to raise their families according to their own right and style.”

Messer said he and Schupp have agreed to try to come to consensus on the issue, unlike previous sessions.

“We’re talking to see what kind of common ground we can agree on,” Messer said. “We’re not at the end of that. But I appreciate it greatly that she’s taking a proactive approach to reach out and she’s made some adjustments in the language that are positive, but we’re not far enough along yet.”

This is the fifth year Nathan’s Law has been proposed. Last year parts of it were rolled into another child care safety law called Sam Pratt’s Law that passed at the end of the session. That law gave judges the right to shut down illegal day cares where the child care provider has been charged with child abuse or neglect. It also raised the fines a local prosecutor can lodge against an illegal home day care and required unregulated child care providers to publicly post that they are unlicensed.

Even so, proponents of Nathan’s Law were disappointed the bill was stripped of a key proposal requiring home day care operators to include in their enrollment count any young children who are related to them — so disappointed the name Nathan’s Law was taken off the bill. Under current law, a home day care must be licensed if the provider watches more than four children. However, the law says a child care provider’s children, grandchildren, nieces and nephews do not have to be a part of that count.

That means, many home day care providers can remain unlicensed even though they are watching far more than four children. Eliminating the related-child exemption for younger children would more closely align Missouri with the majority of states nationwide. Most require related children who are younger than school age to be counted. For example, Oklahoma requires every child to be counted, while Illinois allows just one related child to be exempted from the count.

Schupp said this year’s version of the bill better clarifies the age at which a related child must be counted in a home day care enrollment. That is intended to better explain to in-home child care providers and home schoolers when licensing would apply to them. Under the revised bill, related “children who are eligible for enrollment in a public kindergarten or elementary school will not be considered in the number of children being cared for” in the home day care.

Schupp said this law has no affect on families who do not run day cares in their homes. But, for those who do, she said related children younger than school age require more supervision and should be in the enrollment count. If that enrollment goes above four, the caregiver should have a license and be subject to state oversight, she said.

“Of course we would never intervene in a family’s ability to watch their own children,” she said. “But once you bring in somebody from outside the family into your day care, that person who is paying for a service needs to be assured that service is provided in a safe way,” she said.

The law is named after Nathan Blecha, who died in 2007 at age 3 months after accidentally suffocating in some bedding while napping in a portable crib at an illegal home day care in Jefferson County.

The day Nathan died, the caregiver was watching four grandchildren and six unrelated children without a required license. Under state law the caregiver was breaking the state enrollment limit of four by two children, even though she was actually watching six additional children.

In the aftermath, Nathan’s parents learned that state regulators had no ability to shut down an illegal home day care, even where a child had died. Nor was the provider fined for running a rogue day care. A Post-Dispatch investigation of deaths in home day cares later found that illegal home day care operators, when discovered, were rarely fined and often continued to break the law.

Last summer the Post-Dispatch also reported on more than a dozen unlicensed home day cares catering to as many as 30 children a day that were being allowed to operate in rural Barry County. The county prosecutor there refused to fine them, despite being repeatedly notified by state regulators that providers were breaking state law. State regulators currently have no power to shut them down on their own.

Nathan’s Law would give the state Department of Health and Senior Services the power to shut down such chronic, illegal day cares.

Messer said his network backs a proposal to give the state more power to shut down illegal home day cares operating without a required license. He said the vast majority of accidents and crimes against children occur in blatantly illegal day cares that operate without proper licensing. That has unfairly affected legally unlicensed home day cares that operate safely with the related child exemption, Messer said.

But Schupp said Nathan’s death highlights a critical flaw in the exemption that can lead to child care providers watching too many children and making poor safety decisions. Nathan’s mother, Shelley Blecha, said she believes poor supervision was a factor in her son’s death, even though it was ruled an accident.

“I think if there hadn’t been so many kids there, the caregiver would have been more attentive to Nathan and she would have noticed that the bedding in his bed was all smashed up and loose against his face, and that she would have gone on and checked him earlier,” Blecha said.

Schupp is currently lobbying for co-sponsors. She said she already has bipartisan support.

I am so excited that there will be a new version of "Nathan's Law" filed by Representative Jill Schupp this year! When I have a bill number and the final wording I will post that too! I am determined to keep fighting and make this a law. Way too many babies have died in the state of Missouri and something has to be done. I hope this is the year to finally get this bill passed.

This Monday, I will be attending the Legislative Panel on Early Childhood Development in Missouri. Representative Schupp will be there, along with another Representative and a few Senators. I am hoping to speak with the Senators and getting one of them to agree to file "Nathan's Law" on the Senate side too. Wish me luck!

I know, I know, it has been a REALLY long time since I have posted anything. What can I say, life has got in the way. Between kids, work, kids, husband, kids, house, kids, trying to not lose my sanity, did I mention kids, I have had very little time. Anyway so much has happened, I will try to give a brief overview and hopefully have more time later to fill in the blanks.

So, Nathan's Law did not pass this year, but parts of it did. Sam Pratt's Law did pass! There were some changes to Sam Pratt's Law though.One of those items I will post about in more detail later. Two of the provisions of Nathan's Law were tacked on to Sam Pratt's Law and will go into affect with the passage of Sam Pratt's Law. Those items were, that providers need to disclose to the guardians of the children they are watching whether they are licensed or not and the fine will increase from $200 to $200 a day, up to $10,000. Since what I consider to be the most important parts of Nathan's Law did not pass, my husband and I chose to take Nathan's name off the bill. I am very happy about the fine increasing and hope it does make a difference. The fight is not over yet. I hope to file Nathan's Law again this legislative year. I still strongly feel something needs to happen with the related children not counting in the total head count and the Division of Family Services needs to have more power to close down these individuals who are running illegal daycares. So, once the election is over, I hope to find a new sponsor.

Well, The Today Show did not happen. We had everything scheduled and then Whitney Houston died and that took over. I have not heard from them since then. I was hoping to get a call back to reschedule, but so far have not heard anything.

This is a summary of what has been going on. I will try to post more about the passage of Sam Pratt's Law. I am so happy for Sam's family for the fight to get this law passed. I am so honored I have had the opportunity to meet them and work with them on trying to make daycares safer for our children!

Yesterday, I received a call from The Today Show! I spoke with a super nice lady, Avni Patel, who is one of their reporters. We spoke for nearly an hour about Nathan, home day care, Nathan's Law, overall childcare, etc. She wants to come out to Missouri to interview me!

Sounds like they are going to do a series on child care in America and all the issues with it. Several other parents will be interviewed too. This is so exciting! Hopefully all this publicity will finally help make some major changes in child care in Missouri and across the country!

So much has happened in the last few months! I am not even sure where to begin. First I have to thank Nancy Cambria with the Saint Louis Post Dispatch. Without all of the wonderful articles she has written, I don't think we would have made it as far as we have this year!

Well, to begin with we have three bills this year!!!!!!!!!!!!! One on the Senate side, SB448 (Senator Rupp), and two on the House side, HB1145 (Representative Gatschenberger) and HB1350 (Representative Schupp). SB448 and HB1145 are the same. Both have both Nathan's Law and Sam Pratt's Law combined on them. HB1350 is just Nathan's Law. Below is a summary of SB448.

This act authorizes the Department of Health and Senior Services to investigate child care providers who are exempt from licensure if the department learns or is notified that such provider has pending criminal charges.

The department is also authorized to prohibit a licensure exempt child care provider from continuing to provide child care services if there are criminal charges pending against him or her that would similarly result in licensure actions for a licensed child care provider. Such licensure exempt provider shall be prohibited from continuing services pending a resolution of such criminal charges in favor of the provider.

Any licensure exempt child care provider who continues to provide child care services after notification by the department to stop such services shall be guilty of a Class B misdemeanor for the first violation and a Class A misdemeanor for any subsequent violation.

The department shall report any known violation to an appropriate prosecuting attorney's office or law enforcement agency. SECTION 210.165

NATHAN'S LAW

Under current law, a child care provider may be exempt from licensure if the person is caring for four or fewer children and children who are related to the provider are not considered in the total number of children being cared for. This act provides that such relative children shall be included in the total number of children being counted, except that children of such person who live in the home and attend school for a full school day shall not be included in the total number cared for. Any child-care facility exempt from licensure shall disclose the licensure-exempt status to the parents or guardians of children for which the facility provides care.

This act increases the penalty for violations of child care licensure provisions to include a fine of two hundred dollars per day, not to exceed a total of ten thousand dollars for subsequent offenses.

This act also authorizes the Department of Health and Senior Services to immediately close any illegally operating unlicensed child-care facility. The prosecuting attorney of the county where such illegal child-care facility is located may file suit for a permanent order preventing the operation of a child-care facility. The order shall remain in effect until such time as the court determines that the child-care facility is in compliance with all licensure requirements. Any person who operates an illegal unlicensed child-care facility shall be subject to penalties prescribed under the act. SECTIONS 210.209, 210.211, 210.245

Next week, Tuesday, February 14, SB448 is scheduled for a hearing in front of the Committee of Health, Mental Health, Seniors and Families. Unfortunately I am unable to attend, but will be sending in written testimony. I know several people will be able to attend the hearing and show their support!

Also, this year, there will be a special rally for both Nathan's Law and Sam Pratt's Law. The rally will in Jefferson City on February 28. When I have more detail, I will post them.

Then on March 28, Child Advocacy Day will be held in Jefferson City. This is a great time to speak to legislators about the issues with child care.

Debbie Thrasher, grandmother of four, gave herself a weekend to sulk, then shook off her disappointment and took out a pen.

She began addressing another thousand postcards to lawmakers to let them know what happened to her baby grandson Sam in an unlicensed home day care in Pilot Knob, Mo.

In May, a child care safety bill named in Sam's memory had failed again - this time in the last hours of the 2011 Missouri legislative session. Thrasher already had handed out more than 5,000 postcards for people to mail to legislators, enough for each to receive dozens. Thrasher hoped the new cards might tip the scales next year.

William "Sam" Pratt died in 2009 of suspected child abuse. His caregiver, Martha Farris, is facing manslaughter charges. Yet Farris was allowed to continue to care for children. Neither state regulators nor police had any way to stop her.

Sam Pratt's Law would allow regulators to bar all child care providers facing serious criminal charges from watching children. Thrasher, who owns a licensed child care facility, said the state should have the same power to shut down unlicensed providers as it has with licensed ones.

At the same time, Shelley Blecha also lamented a failed bill. For three years she had testified in Jefferson City and Washington on child care safety. Her 3-month-old, Nathan, accidentally suffocated in a home day care where the provider was caring for 10 children without a required license.

Nathan's Law would increase fines in an effort to deter unlicensed providers from breaking the law by caring for too many kids. It also would modify a state exemption that allows unlicensed providers to care for an unlimited number of children who are related to them.

Like Sam Pratt's Law, Nathan's Law was defeated in the Senate.

The families were disappointed but not surprised.

That's because Missouri lawmakers and policymakers have a long history of doing the bare minimum - or nothing - to enact laws that could curtail preventable child deaths.

On Sunday, the Post-Dispatch reported that at least 45 children died in Missouri child care settings from 2007 through 2010 for reasons other than natural causes.

The investigation showed the vast majority of those deaths - 41 in all - occurred in unlicensed and unregulated settings where state inspectors have little reach.

Critics call Missouri's regulation inadequate in three areas.

First, the state exempts more forms of child care from regulation than most other states, allowing an estimated 5,000 or more facilities - serving perhaps 60 percent of children in care - to operate without licenses or inspections.

Second, providers who do fall under the state's licensing guidelines are governed by outdated regulations. For example, the state is far behind in creating rules to prevent sleep deaths - by far the most common cause of the recent deaths.

The wait for updated standards has been agonizing for parents like Shelley Blecha.

"How many more children are going to have to die before the state does something?" she asked. Her son would have turned 4 in March.

SACRED EXEMPTIONS

When infants die and bills are drafted, some legislators and lobbyists characterize the deaths as isolated incidents, not a possible epidemic.

Last year, former state Rep. Cynthia Davis, R-O'Fallon, called Sam Pratt's Law a "souvenir" bill designed to soothe his grieving family. Davis refused to hear testimony in her children and families committee, and the bill died.

Smaller child care providers oppose further regulation, fearing it will drive them out of business. Lawmakers, particularly in rural and poor communities, take that opposition seriously.

To lose those home-based settings could drive parents to choose less safe, less stable child care, said Pam Mitchell, of the Child Day Care Association, which refers parents to licensed day cares in the region.

The Legislature has generally regarded two key exemptions in child care law to be sacred. The first excludes children who are relatives of a caregiver from being counted for licensing. The second allows faith-based facilities to avoid all but basic fire and health inspections.

Kerry Messer, president of the Missouri Family Network, which represents conservative Christian groups, said families and churches believe those exemptions are fundamental rights.

"They feel a lot of apprehension and fear about the state coming in and telling them how they can and cannot raise their children in their homes. And they are legitimate concerns," he said. "They are under almost nonstop attack from the bureaucrats and from the money-making child care industry who are trying to chip away and do away with these exemptions."

Support for the faith-based exemption is backed by Missouri's many religious-based residential centers for troubled youths.

Woody Cozad, a lobbyist for one center and former chairman of the Missouri Republican Party, told a House committee in March that Sam Pratt's Law could enable the state to harass faith-based facilities.

Cozad pushed for and was given an exemption for faith-based day cares. But when the bill came to the floor for debate, Sen. Jolie Justus, D-Kansas City, said all providers should be under the same standards. Justus relented, but the bill stalled.

Messer said the dangers to children lurk in licensed care, not church-based or unlicensed home care.

And, the Post-Dispatch analysis found no deaths in the state's 671 faith-based facilities, which by law must register with the state.

However, the analysis found 41 of 45 deaths happened in unlicensed home day cares that aren't required to follow state standards or undergo routine inspections.

Licensing exemptions for child care are also common elsewhere.

Only 11 states require licensing from the moment a caregiver begins regularly watching one or more unrelated children in a home for profit, according to a recent survey by the National Association of Child Care Resource and Referral Agencies. The same group faulted 17 states because they required no licensing for home day cares regardless of size, or provided few or no inspections or allowed more than six children in care.

Even among that group, Missouri ranks near the bottom.

State law allows a provider to care for a maximum of four children without a license. But Missouri is one of just four states that also permits an unlicensed provider to care for an unlimited number of children who are relatives, regardless of the children's ages. That allows the number of children under one person's care to soar - such as in Nathan's home day care.

Illinois, in contrast, counts all children under 12, regardless of their relation to the caregiver.

Advocates for child care reforms say the more exemptions to regulation, the greater danger to children and the more confusion for parents who think they are paying for trained, regulated and monitored child care providers, when they are not.

"It's pretty striking what parents think they are getting versus what they are getting in Missouri," said Carol Scott, chief executive officer of Child Care Aware of Missouri. "The number of exemptions and the variety of exemptions confuses the parent-consumer about what they're buying."

OUTDATED RULES

It's not just that hundreds of providers are exempt from licensing that troubles safety advocates.

They say even licensed and fully regulated providers in Missouri are held to low standards that fail to consider decades of research on child safety.

The bulk of Missouri's licensing and safety rules are more than 20 years old and haven't had a wholesale revision - ever.

Until August, Missouri had minimal sleep death prevention rules on the books for licensed centers - such as a ban on smoking and requirements to use cribs and snug mattresses. Thirty-seven states did better, according to a 2006 survey done by a nationally recognized researcher on sudden infant death syndrome. Most banned pillows in cribs. Others made safe-sleep training mandatory.

Advocates say those rules have reduced fatalities in child care.

In Illinois, child care rules are updated on a regular cycle as new research on child safety is completed.

But in Missouri, it took five years for state licensing officials to gain consensus among child care providers to enact even the most basic of safety updates.

Budget cuts thwarted a plan to use consultants and public hearings to rework large parts of the regulations. Instead, the state is rolling out small changes, piece by piece.

These include a rule that took effect in August requiring licensed providers to place infants on their backs for naps and rules set for January requiring CPR and first aid training for some staff.

Margaret Donnelly, director of the state Department of Health and Senior Services, said the new rules will save lives.

SIDS prevention groups also praised the new sleep rule but said it was inadequate to cover all risks related to sleep deaths.

"They need to get all the junk out of the crib - no bumper pads, no blankets, no pillows," said Mary Adkins, director of Project Impact, a federally funded resource center on sudden unexpected infant death. "A safe crib, coupled with consistent training and rules to create safe sleeping environments, can reduce the likelihood of infant death."

A CALL TO ACTION

But even if Missouri had the strongest rules, their reach would be limited because regulations affect only licensed day cares. Most sleep deaths occurred in unlicensed care. Even when deaths occur in unlicensed day cares that exceed state enrollment limits, the state lacks meaningful punishments.

That became apparent this summer in the courtroom of St. Louis County Judge Lawrence Permuter.

On Aug. 4, Alva Roberts pleaded guilty on two counts of running an illegal day care in her Valley Park home - offenses that carried fines of just $400.

Last year Tyler Brody suffocated under a blanket in her care. State documents show Roberts was watching at least eight children under 2 the day Tyler died.

At the hearing, Tyler's parents and Roberts gathered in a semicircle in front of the judge. Over the objections of Roberts' attorney, Stacey Brody was allowed to read a victim's impact statement.

She told the judge both Nathan's Law and Sam Pratt's Law would have prevented Roberts from caring for kids. She said the system failed Tyler when it did not prosecute Roberts earlier for running an illegally unlicensed day care in another county.

"If that had happened, we would not be here today."

In a soft voice, Permuter called the hearing one of the saddest ever on his bench.

"There's just not that much they could have done, unfortunately, under the current law," he said of prosecutors.

"So, you know, it's up to the citizens of the state of Missouri to become aware of what's happened to you. And it's up to the politicians and the system and the legislators in Jefferson City to do the right things and pass these laws."